Claims Processor (53334)

GlobalHealth, Inc.; Oklahoma City (OK); Remote; USD 42,000 - 54,000; Full time

Job summary

GlobalHealth, Inc. is seeking a Claims Processor to handle all types of Medicare, Medicaid, and Commercial insurance claims with accuracy and efficiency. The role supports the Team Leader and Claims Supervisor to meet regulatory standards for quantity, quality, and timeliness.

Ideal candidates will have a high school diploma and 2+ years of medical claims processing experience, strong communication skills, and a commitment to confidentiality and HIPAA compliance.

Qualifications

• High school diploma or equivalent required.
• Two years of medical claims processing experience preferred.
• Strong understanding of insurance processes (Medicare/Medicaid/Commercial).
• PHI confidentiality and HIPAA compliance knowledge.

Responsibilities

• Process all types of claims accurately and timely per HCFA1500/UB92 guidelines.
• Review processed and pended claims with supervisor for accuracy and timeliness.
• Coordinate with Claims Manager on resolution of customer service inquiries within 24 hours.
• Assist with claims adjustment projects as requested.
• May assist with claims entry as needed.
• Maintain desk procedures and reference materials.

Skills

Attention to detail

Verbal communication

Written communication

Organizational skills

Analytical thinking

Problem-solving

Self-motivated

Education

High school diploma or equivalent

Job description

Who We Are

GlobalHealth is a fast-growing Medicare Advantage HMO health insurer. We aspire to be the employer of choice in our industry, attracting and retaining a highly talented workforce. Our passion is Genuine Care and Optimal Health for the members we serve. We are unique by providing high touch, high value and a partnership to our members. We go above and beyond to provide personalized, engaging, and responsive services to our members. We work hard to offer affordable health insurance coverage with the benefits people truly want and need. It is our hope to be more than just a health insurance company we want to be long-term partners with our members. We are looking for future employees who exude our core values of taking accountability through ownership, being driven, innovative and who have a passion for continuous learning.

Who We Are

GlobalHealth is a fast-growing Medicare Advantage HMO health insurer. We aspire to be the employer of choice in our industry, attracting and retaining a highly talented workforce. Our passion is Genuine Care and Optimal Health for the members we serve. We are unique by providing high touch, high value and a partnership to our members. We go above and beyond to provide personalized, engaging, and responsive services to our members. We work hard to offer affordable health insurance coverage with the benefits people truly want and need. It is our hope to be more than just a health insurance company we want to be long-term partners with our members. We are looking for future employees who exude our core values of taking accountability through ownership, being driven, innovative and who have a passion for continuous learning.

Who You Are

The Claims Processor is primarily responsible for processing all types of contracted and non-contracted claims accurately and timely for Medicare, Medicaid and Commercial Insurance products. The Claims Processor works directly with the Team Leader and/or Claims Supervisor on the day-to-day operations of the Claims for the purpose of meeting the company, department and regulatory standards for quantity, quality, and timeliness. This position requires the ability to work independently, accomplish goals, excellent customer service and communication skills.

Essential Job Functions

• Processes claims based on the productivity and quality standard set (HCFA1500 and UB92) per day in accordance with contractual and non-contractual agreements and processing guidelines.
• Works with Claims Supervisor or Manager in review of processed and pended claims to ensure appropriate, timely and accurate claims processing.
• Coordinates with Claims Manager on resolution of customer service inquiries within 24 hours of receipt.
• Assist with Claims adjustment projects as requested.
• May help with Claims entry when requested.
• Completes various work assignments as requested by supervisor in a timely manner.
• Maintains current desk procedures and reference materials.
• Must maintain confidentiality of business information, including Protected Health Information (PHI), as required by HIPAA and company policy.
• Performs other duties as assigned.

Education And Experience

• High school diploma or equivalent required.
• Two year of medical claims processing experience strongly preferred.

Knowledge, Skills And Abilities

• Must have full understanding of insurance processes (Managed Care, Medicare, Medicaid and Commercial practices).
• Working knowledge of medical claims processing guidelines and practices.
• Knowledge of Medicare and Health Care Finance Administration regulations.
• Knowledge of EOBs, CPT & ICD-10 codes, HCFAs, UB04s, HCPCS, DRGs and authorizations/referrals.
• Ability to read and interpret provider contracts.
• Strong verbal, written and organizational skills, must be self-directed/self-motivated and must have analytical, problem-solving, and decision-making abilities.
• Accurate keyboard skills.
• Ability to function in a fast-paced, detail-oriented environment.
• Basic math skills.
• High degree of accuracy.
• Team player.

Work Environment

• Current work environment is remote, however, some state exclusions apply.

Must have access to a reliable and secured internet connection source. Work environment must maintain confidentiality of business information, including Protected Health Information (PHI), as required by HIPAA and company policy. This position will also be required to use reasonable and necessary safeguards to protect GlobalHealth records from unauthorized access, disclosure or damage and will adhere to all GlobalHealth privacy and security policies.

Travel

No travel is required

Supervisory Responsibility

This position has no supervisory responsibility

Other Duties

This job description is not designed to cover or contain a comprehensive listing of activities, duties or responsibilities that are required of the employee for this job. Duties, responsibilities and activities may change at any time with or without notice.